EHR Parameters for Pharmacy 1

Learning Objectives Assess need to have a properly configured Information Management system and use of uniform data to assure medication accuracy, timely access to patient information and patient safety. Explain the necessity to configure Information Management system in medication management to correlate to physical processes to assure that the system supports but does not supplant the process. Evaluate package parameters relating to medications and medication use in both outpatient and inpatient settings to function for useability and workflow including IHS specific options, a uniform print format for EHR, controlled substance orders, the PharmEd Button, inpatient user parameters, inpatient ward setup, Ward Groups, Unit Dose Parameters and MAR/MAR Labels. Determine best practices. 2

Definition of Parameter A Parameter is a Quantity whose value is selected for the particular circumstances and in relation to which other variable quantities may be expressed. 3

Definition of Parameter For RPMS-EHR, this means that a CAC can change behavior of a part of the software without having to perform a programming change simply by changing the value of a Parameter. 4

Parameters: Provide a way to Control Configuration at the Local Level by non-programmers Allow for Flexibility and Customization of RPMS-EHR at each Site Allow for different Configuration for Divisions and Individual Users 5

Parameter Structure The Structure of Parameters within RPMS-EHR is Hierarchical Parameters range from User at the top to Package at the bottom 6

Hierarchy Levels 1User 2Team (OE/RR) 3Device 4Location 5Service 6Division 7System 8Package 7

Parameter Hierarchy How does the Hierarchy work? A Package first Checks the Highest Level (e.g. “User”) to see if a Value is set The Package will continue to check each succeeding Level until a Value is found When a Value is found, the Package stops and uses that Value for the Operation in question 8

Parameter Hierarchy Note that not all Levels are available for all Parameters, but only those that make sense for that particular item. ORWOR WRITE ORDERS LIST may be set for the following: 1 User USR [choose from NEW PERSON] 2 Location LOC [choose from HOSPITAL LOCATION] 2.3 Service SRV [choose from SERVICE/SECTION] 2.7 Division DIV [MEDSPHERE DEMO HOSPITAL] 3 System SYS [DEMO.MEDSPHERE.COM] 4 Package PKG [ORDER ENTRY/RESULTS REPORTING] 9

Setting Parameters Most Parameters are set at the System or Division Level. For some Parameters, it may be necessary to use Location, Team or User. The “higher” the level used, the more effort required to maintain the Parameter (e.g. 1 Setting at System, vs. 30 at Location, vs. 300 at User). 10

Setting Parameters Package levels should NOT be changed by the CAC. The Package Level should be considered the “Reference” Value. New Patches for a Package may sometimes reset the Package Level value which could have interesting consequences if was changed locally. 11

Setting Parameters RPMS-EHR Parameters can be set in two ways: Using the RPMS menu option: General Parameter Tools Using various RPMS menus from: RPMS-EHR Configuration Master Menu 12

Parameters – Meds CORE-EHR-BEH-MED ACTDays of Medication Activity DEA Print DEA on all Prescriptions MAXMaximum Allowable Days Supply MECMedication Counseling Configuration OMD Outside Med Dosage Form ORD Default Collation Order REN Renewal Limit for Expired Meds SPL Med Tab Splitter Size 13

Days of Medication Activity 14

Print DEA on all Prescriptions Allows for local customization for DEA printing on all prescriptions instead of only on controlled prescriptions. 15

Maximum Allowable Days Supply This controls the upper limit for days supply of a dispensed medication: The range is days. 16

Medication Counseling Configuration 17

Medication Counseling Configuration DCMPDefault Comprehension Value DCTMDefault Counsel Time EDTXEdit Disclaimer Text ELSTEducation Topics HLHospital Location for Visit PLSTPOV List DPOVDefault POV PNLPOV Narrative Text 18

Medication Counseling Configuration Default Comprehension ValueDefault Counsel Time 19

Medication Counseling Configuration Edit Disclaimer Text Education Topics 20

Medication Counseling Configuration Hospital Location for VisitPOV List 21

Medication Counseling Configuration Default POVPOV Narrative Text 22

Outside Med Dosage Form 23

Default Collation Order Controls the default collation order for the medication list. May be one or more of the following values: C = Chronic med status E = Expiration date F = Last fill date I = Issue date M = Medication name N = Rx # P = Provider name R = Refills remaining S = Status To reverse the collation order, use the lowercase equivalent. 24

Default Collation Order 25

Renewal Limit for Expired Meds This is the maximum number of days following the expiration of a prescription that it may still be renewed: Typically set to between days. 26

Parameters – Ordering CORE-EHR-BEH-ORD-PAR HLD Disable Hold/Unhold Actions in EHR IND Enable Clinical Indicator Prompt MSC Miscellaneous Parameters ORD Disable Ordering in EHR RSN Edit DC Reasons UOV Set Unsigned Orders View on Exit VER Enable/Disable Order Verify Actions 27

Enable Clinical Indicator Prompt Places a prompt for providers to enter a clinical indication for medication orders. Required to be turned on for e-prescribing. EHR Patch 9: Requires a coded diagnosis Pull in problem list and POVs for providers to select from Renew, copy, and change pre-populates with clinical indication of new order 28

Clinical Indication prompt 29

Ordering - Miscellaneous Parameters CORE-EHR-BEH-ORD-PAR-MSC Active Orders Context Hours24 Allow Clerks to act on Med Orders NO Allow Clerks to act on Outside Med Orders Auto Unflag YES Confirm Provider YES (Exclude ORES) Default Provider Error Days 7 New Orders Default Sign & Release Restrict Requestor YES (ORELSE & OREMAS) Review on Patient Movement NO Show Lab # YES Show Status Description YES Signature Default Action Release w/o Signature Signed on Chart Default NO 30

Parameters - Order Checks CORE-EHR-BEH-ORD-OCX CONCreatinine Date Range for Contrast Media Orders CTHCT Scanner Height Limit CTWCT Scanner Weight Limit DANSet Clinical Danger Level DBGEnable/Disable Debug Message Logging DPLLab Duplicate Order Range DPOOrderable Item Duplicate Order Range DPRRadiology Duplicate Order Range EDTMark Order Checks Editable by User ENAEnable/Disable an Order Check GLUCreatinine Date Range for Glucophage-Lab Results LCLEdit Local Terms MRHMRI Scanner Height Limit MRWMRI Scanner Weight Limit PLYNumber of Medications for Polypharmacy USROrder Checks a User Can Receive 31

Parameters – Notifications CORE-EHR-NOT DETDetermine Recipients DISDisplay Notifications a User Can Receive ERAErase Notifications FLGFlag Orderable Items to Send Notifications FWDForward Notifications PARNotification Parameters PRCEnable/Disable Notifications RECDisplay Patient Alerts and Alert Recipients SYSEnable/Disable Notification System UNVSet Delays for Unverified Orders URGSet Urgency for Notifications 32

Parameters – Reports CORE-EHR-BEH-RPT FMTPrint Formats HSMHealth Summary Configuration... PARReport Parameters... SYSSystem Display Parameters USRUser Display Parameters 33

EHR Patch 9: Auto-finish & e-Prescribing Parameters BEHORX PRINT LABEL Optional 34

EHR Patch 9: Auto-finish and e-Prescribing Parameters BEHORX PRINT FORMATS DefinitionTemplate TypeSite Specific Template Formats Prescription ControlledPC:RX CII(Site Name) Prescription (CII) Prescription Non-ControlledPN:RX NON-CII(Site Name) Prescription (NON-CII) Order ControlOC:ORDER CII(Site Name) Order for Signature (CII) Order Non-ControlON:ORDER NON-CII(Site Name) Order for Signature (NON-CII) Receipt ControlledRC:RECEIPT CII(Site Name) Receipt (CII) Receipt Non-ControlledRN:RECEIPT NON-CII(Site Name) Receipt (NON-CII) Label ControlledLC:LABEL CIICannot configure at this time Label Non-ControlledLN:LABEL NON-CIICannot configure at this time 35

EHR Patch 9: Auto-finish and e-Prescribing Parameters BEHORX PRINT FORMAT TYPE Template TypeSite Specific Template FormatsDefault Printer PC:RX CIIDemo Prescription (CII)CLIN 1 PN:RX NON-CIIDemo Prescription (NON-CII)CLIN 1 OC:ORDER CIIDemo Order for Signature (CII)CLIN 2 ON:ORDER NON-CIIDemo Order for Signature (NON-CII)CLIN 2 RC:RECEIPT CIIDemo Receipt (CII)CLIN 3 RN:RECEIPT NON-CIIDemo Receipt (NON-CII)CLIN 3 LC:LABEL CIICannot configure at this timeDINOLB 1 LN:LABEL NON-CIICannot configure at this timeDINOLB 2 36

EHR Patch 9: Auto-finish & e-Prescribing Parameters APSP AUTO RX DIV Sets Pharmacy Division to divisions setup in Outpatient Site File Must be done before APSP AUTO RX 37

EHR Patch 9: Auto-finish & e-Prescribing Parameters APSP AUTO RX APSP Auto RX Setting Meaning InternalPatients fill prescriptions written by in-house providers at only in-house pharmacies: In-house options for Clinic, Mail, Window retained CII order for signature queued to print Internal/ExternalPatients fill prescriptions written by in-house providers at in-house and outside pharmacies: In-house options for Clinic, Mail, Window retained – CII order for signature queued to print. Prior to Surescripts® set up/deployment, enables the “Outside Pharmacy – Print” functionality – Auto-finishes medications upon signature and queues prescription for printing. After Surescripts® set up/deployment, enables the “Outside Pharmacy – eRx functionality – Auto finishes medications upon signature, transmits and queues receipt for printing ExternalNo in-house pharmacy: All medication orders auto-finish upon signature Prior to Surescripts® set up/deployment, enables the Outside Pharmacy – Print” functionality – Auto finishes medication upon signature and queues prescription for printing. After Surescripts® set up/deployment, enables the “Outside Pharmacy – eRx functionality – Auto finishes medications upon signature, transmits, and queues receipt for printing 38

EHR Patch 9: Auto-finish & e-Prescribing Parameters APSP AUTO RX SCHEDULE RESTRICT Not editable APSP AUTO RX ERX OF CII Not editable APSP AUTO RX ADD PRV COMMENT Set to NO APSP AUTO RX DEF PT STATUS Set to OUTPATIENT 39

EHR Patch 9 – New Printing Functionality “Smart logic” is used to determine which order requires a print job and if so which type based on: Status (Active or Pending) Pick up location Type of drug (Controlled or not) “Queues” the print jobs for printing. Formats may be defaulted to specific templates. Formats may be defaulted to specific printers at the User, Location, Division and System level. 40

Queue Print Facility type Pick up locationStatus after signing CII?Print formatIcon InternalClinic Mail Window Clinic Window Pending No Yes N/A CII Order for Sig ExternalClinic Outside Pharmacy – eRx Outside Pharmacy - Print Active No Yes No Yes N/A Prescription (CII) Prescription (Non CII) Prescription (CII) 41

Queue Print Facility type Pick up locationStatus after signing CII?Print formatIcon Internal/ External Clinic Mail Window Pending No N/A Clinic Window Pending Yes CII Order for Sig Outside Pharmacy – eRx Outside Pharmacy - Print Active No Yes Prescription (Non CII) Prescription (CII) 42

Queue Print After signing, the meds that have print jobs are highlighted and the Queue Print button is active 43

Queue Print Click the Queue Print button and the print jobs are displayed, associated with pre-defined templates for each format and default printer (user may change) 44

Rx Print Format (Template) editor Set up: 1.Design mode> Desktop Properties> Custom Menus 2.Add Menu item “Rx Template Editor” 3.Add the following in Action (lightening bolt) $(BEHRXGENERATORSERVICE.RXGENERATOR.edittemplates) 4.Click Apply and Ok 5.Make sure you have BEH Rx Generator Service checked under “required services” 6.Only place on EHR GUI templates of those who are responsible for editing Prescription formats (ie. CAC, pharmacy Ad Pac) 45

Rx Print Format (Template) Editor Design ModeRx Template Editor 46

Rx Print Format (Template) Editor Template type (format) Prescription (Non-CII) Prescription (CII) Order for signature (CII) Order for signature (Non-CII) Receipt (Non-CII) Receipt (CII) Template Default template for each template type delivered with EHRp9 47

Rx Print Format (Template) Editor Importing template: 1.Save the files to a local drive 2.Open Rx template editor 3.Select template type 4.Click Import 5.Change the name if desired, click OK The files are.ptxml files 6.Click “active on” 7.Select Yesterday at 6:00 am, then OK 8.Now you may edit the template 9.Click OK to store 48

Rx Print Format (Template) Editor Active on – set activation date (usually Yesterday at 6:00am) Preview – Display preview of current template Import – import template Export – export template Add Free Text – you may add as many as you like. May include header info for format, alternate signature lines, etc. Mark Inactive – inactivates template so users cannot select 50 *** Tip *** To Copy a template - export, save and import: - Change to a local name on imports. - Set “active on” to Yesterday at 6:00 am. - Make changes then click OK Highly recommend using the copy process and creating local templates rather than editing nationally delivered default templates ***

Rx Print Format (Template) Editor Change font Set fields for inclusion, change print labels, and set columns in the Fields section 51

Rx Printer Configuration In RPMS set the BEHORX PRINT FORMATS parameter Associates the Format type with the Format (Template) May set at User, Class, Location, Division and System level Most commonly will be set at System or Division level Select Format Type: ?? Instance values are (Commonly set format types) : PC:RX CII PN:RX NON-CII OC:ORDER CII ON:ORDER NON-CII RC:RECEIPT CII RN:RECEIPT NON-CII LC:LABEL CII LN:LABEL NON-CII 52

Rx Printer Configuration 53

Rx Printer Configuration Populate the BEHORX PRINT FORMAT TYPE This associates the Format type: Order for signature (CII) Prescription (CII) Prescription (Non-CII) Receipt (Non-CII) with a default printer. Set at User, Location, Division or System level In RPMS or in EHR Printer Preferences tool 54

Rx Printer Preferences Editor Set up: 1.Design mode> Desktop Properties> Custom Menus 2.Add Menu item “Rx Printer Config” 3.Add the following in Action (lightening bolt) $(BEHRXGENERATORSERVICE.RXGENERATOR.EditPrinterPreferences) 4.Click Apply and Ok 5.Make sure you have BEH Rx Generator Service checked under “required services” 6.Users will only be able to set their own defaults 7.Assign the BEHORX PRINT key for CAC/IT staff who will set Location, Division, System settings 55

Rx Printer Preferences Editor Design ModePrinter Preferences 56

Rx Printer Preferences Editor Use dropdown to select level, template type, printer settings. Click APPY to store the parameter. To remove a parameter level, bring up the level and click REMOVE 57

Rx Printer Preferences Editor RPMS display parameter BEHORX PRINT FORMAT TYPE RPMS enter/edit parameter BEHORX PRINT FORMAT TYPE 58

Questions and Discussion 59